Dear Dr. Roach: I have been diagnosed with piriformis syndrome, which has the same symptoms as sciatica. I have been to a chiropractor and doctor, and I still have pain shooting down my leg. I have been taking painkillers and anti-inflammatories but have found no relief. Do you have any suggestions? M.W.
I think piriformis syndrome is a more common cause of back pain than is usually realized. It feels like sciatica because the sciatic nerve is indeed being compressed, just like in people with a herniated disk, but in piriformis syndrome, it鈥檚 the piriformis muscle, deep in the hip, that presses on the nerve, causing the pain to feel like it鈥檚 shooting down the leg. Trauma, leg-length discrepancy (one leg longer than the other) and hip or knee injury can predispose one to piriformis syndrome.
Physical therapy is the best treatment for piriformis syndrome. Stretching, ultrasound, exercise and, sometimes, electrical stimulation are effective for most cases. I have read that some cases require surgery, but this is rare.
Dear Dr. Roach: I am 52 years old, and my mom is 74. We are in good health, from a long line of healthy people who live into their 90s. In the past year, I鈥檝e noticed that the base of both of my thumbs really aches in the evening, and I know my mom鈥檚 thumbs have hurt her for years. In the afternoon/evening, I can barely open a jar.
A friend had the same problem, and her doctor put big splints on her hands that immobilize her thumbs, but they are very bulky. I was thinking I could tape my thumbs to my hands to give them a rest, but of course that would make daily life quite a hassle.
I鈥檓 not ready to look into arthritis medication (my physical therapist suspects arthritis), but are there any dietary or lifestyle changes I can make? L.C.
Thumb pain can be caused by many different conditions, and you need to find out what is causing yours before starting treatment. Arthritis does sound like a likely cause, and it can be diagnosed easily via hand X-rays. Immobilization makes arthritis worse.
It sounds like your friend may have had de Quervain鈥檚 tenosynovitis, which is inflammation around two of the thumb tendons. Treatment for that condition is with splints that immobilize the thumb. Sometimes steroid injection is involved. De Quervain鈥檚 tendonitis is diagnosed by physical exam. If your regular doctor needs help, you might see a rheumatologist, a sports-medicine doctor or an orthopedic surgeon.
Dear Dr. Roach: I recently was diagnosed by an allergist with non-allergic vasomotor rhinitis. Could you explain what this is, and how I can best manage it? D.F.
Non-allergic vasomotor rhinitis is the extremely common combination of runny nose, congestion and/ or sneezing for no clear reason. If you鈥檝e ever come inside from the cold and noticed that your nose keeps running for some time, that鈥檚 vasomotor rhinitis. Some people have those symptoms much or all of the time. Sometimes symptoms are triggered by specific things, such as foods, odours or the environment, like the above-mentioned temperature change.
Your allergist has looked for allergies, the other main cause of these symptoms.
If avoiding triggers doesn鈥檛 work for you or you can鈥檛 figure out what your trigger is, then a trial of prescription nasal spray, such as ipratropium or azelastine, usually is effective.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
